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UNDERSTANDING
GASTRIC BYPASS ROUX- EN -Y (RNY)
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What is Gastric Bypass Roux-en-Y ?
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How does the Gastric Bypass surgery work ?
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Laparoscopic Gastric Bypass Roux-en-Y
- Advantages
of Laparoscopic Gastric Bypass RNY
- Risks
Specific to Laparoscopic Gastric Bypass RNY
- Your
Role After Gastric Bypass Surgery
- Frequently
Asked Questions
Advantages
of Laparoscopic Gastric Bypass RNY
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After
gastric bypass surgery, weight loss is more predictable and
usually maintained. Average excess weight loss is usually
higher than with purely restrictive procedures. |
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One year
after surgery, weight loss can average 65% to 70% of excess
body weight. After 10 to 14 years, some patients have
maintained 50-60% of excess body weight loss. |
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96% of
certain associated health conditions (back pain, sleep
apnea, high blood pressure, diabetes and depression) were
improved or resolved according to a 2000 study of 500
patients. It also helps in leg swelling, high cholesterol,
urinary incontinence etc. |
Risks
Specific to Laparoscopic Gastric Bypass RNY
While
we take all measures to prevent complications, some are
unavoidable. You must understand these risks in order to make an
informed consent.
(A) Early
complications
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Bleeding
: If a large amount of blood is lost, you may
require a transfusion. The chances of your requiring blood
transfusion are less than 4 percent. Rarely delayed bleeding
may require re-surgery. |
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Lung
problems: Anyone undergoing general anesthesia has
a risk of having breathing problems. Excess weight places
extra stress on the chest cavity and lungs. This means a
greater risk of breathing problems and pneumonia developing
after surgery. Stopping smoking four weeks before surgery,
sitting up in the bed in the evening after surgery and
performing breathing exercises will help in decreasing the
risk. |
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Venous
thrombosis or blood clots in the leg occur more
often in obese. Smoking and hormone pills increase the risk.
The clot can migrate to lungs causing Pulmonary Embolism.
With this in mind, heparin therapy and compression stockings
are used in all patients with surgery. The best way to
reduce this risk is to exercise the leg muscles to promote
blood flow. Walking is the best therapy to prevent blood
clots, but even moving the feet and ankles up and down while
lying in bed helps. |
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Leak
at one of the staple lines in the stomach can occur
in about 2 % of gastric bypass surgeries. Leakage of
digestive juices and acid can cause peritonitis. This may
necessitate an emergency surgery to stop or drain the leak. |
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Bowel
obstructions may develop anytime after surgery.
Most common causes are adhesions (scar formation) and
internal herniation. It may require a repeat laparoscopy or
sometimes even open surgery to relieve the obstruction. |
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Infections in the incision occur in about 2% of patients after
laparoscopic gastric bypass surgery. These may sometime
require drainage and regular dressings so that they heal
from inside out. Occasionally, in a serious infection, a
second surgery may be required. |
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.Death.
About 1 in 200 to 1 in 300 people who had gastric bypass
surgery in the United States dies from the procedure. With
laparoscopic gastric bypass, the average mortality is
significantly less. Weight experts and bariatric surgeons
consider the known risks and health dangers of severe
obesity to be greater than those resulting from weight loss
surgery |
(B)
Late complications |
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Dumping
syndrome. When stomach contents are literally "dumped"
rapidly into the small intestine. Usually triggered by too
much sugar or large amounts of food, dumping syndrome
doesn't pose a health risk, but its symptoms aren't fun:
nausea, weakness, sweating, faintness, and diarrhea. Some
patients can prevent dumping syndrome by avoiding sweets
after surgery. |
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Bowel
problems. After surgery, there may be a period of
intestinal adaptation during which bowel movements can be
liquid and frequent. This bowel complaint, frequently
accompanied by bloating, gas and foul smelling stools, may
reduce with time. |
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In the
first three to six months, the patient may experience one or
more of the following changes as the body reacts to rapid
weight loss:
Body aches
Feeling tired, like one
has the flu
Feeling cold when others feel comfortable
Dry skin
Hair thinning and hair loss
Changes
in mood
Relationship issues |
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Patients
may develop gallstones after rapidly losing weight in about
30% of cases. The risk of gallstones can be reduced to 2% by
taking bile salts for 6 months following surgery. |
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A
hernia or weakness in the incision occurs in about
2 percent of patients after laparoscopic gastric bypass (15
percent after open weight-reduction surgery). This usually
requires surgical repair, depending on the symptoms and the
extent of the hernia. |
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Narrowing
or "stricture" of the stoma (opening)
between the stomach and intestine is a rare complication.
When foods are not chewed properly and get stuck or have
difficulty passing through the stoma, they cause scarring.
When scarring occurs, it becomes more difficult for the food
to pass. It is suspected when vomiting occurs most of the
times after food. The stoma can be stretched by a gastro
enterologist in the outpatient with a dilating tube that is
passed to the stomach through the mouth (endoscopic
dilatation). |
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An
ulcer where the small intestine is attached to the
upper part of the stomach. Ulcers may occur in 5 percent of
people who have gastric bypass surgery. Ulcers are more
common in people who take aspirin or other medications
called non-steroidal anti-inflammatory agents (NSAIDs). |
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Nutrient
deficiencies: Almost a third of patients develop
nutritional deficiencies. Because the duodenum is bypassed
in this procedure, the body cannot absorb iron, calcium and
other nutrients efficiently after surgery. Fortunately,
these deficiencies can usually be controlled with proper
diet and vitamin supplements.
Iron deficiency
anemia. Because the duodenum is bypassed in this
procedure, the body doesn't absorb iron and calcium very
well after surgery, which can lead to iron deficiency
anemia. This is a particular concern for patients who
experience chronic blood loss during menstruation or from
bleeding hemorrhoids. Taking a tablet daily of multivitamin
and iron will prevent or reverse this process.
Osteoporosis. Because the body doesn't absorb calcium properly
after surgery, there is a greater risk of developing
osteoporosis. Daily supplementations of calcium will prevent
osteoporosis.
Metabolic bone disease.
Also caused by bypassing the duodenum, some patients
experience bone pain, loss of height, humped back and
fractures of the ribs and hip bones.
Chronic
anemia. A type of anemia caused by a deficiency of
vitamin B12 can usually be managed with pills or injections,
which will be taken life long. |
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Diminished
effectiveness. The success of the procedure can be
reduced if the stomach pouch is stretched by intake of large
volumes of food regularly. |
Your
Role After Gastric Bypass Surgery
Although
gastric bypass surgery is a proven and effective way for
morbidly obese patients to lose weight and keep it off, gastric
bypass is a “tool”, not a “magic cure”.
Recognizing and accepting this enables patients to use the
gastric bypass to achieve the goals of weight loss and
maintenance. With this sustained weight loss comes unlimited
benefits, with the most important being improvement or complete
elimination of medical problems related to obesity.
Gastric
Bypass surgery is effective in 85 percent of all people who have
the surgery. Success means the individual must lose at least 50
percent of their excess body weight and maintain that weight
loss for more than five years. Bear in mind, this also means
that 15 percent of all people who have had Gastric Bypass
surgery did not lose weight, or they lost weight but gained it
back within five years.
During the first year
following surgery, the greatest amount of weight loss will
occur. Losing the excess weight is only the first stage of your
weight loss program. The most difficult years are ahead of you.
Recognizing obesity as an addictive disease can help you better
understand the emotional struggles you will be faced with as you
lose weight. The underlying cause of overeating still needs to
be addressed.
In order
to achieve these goals, patients are required to comply with a
rigorous recovery, followed by lifetime changes in eating
behavior. After gastric bypass patients are required to follow a
two-week liquid diet, followed by a two-week pureed
(blanderised) diet. Permanently eliminating concentrated sugar
from the diet is also expected. Because the dumping syndrome
will usually occur after eating sweets, the required elimination
of these from the diet is easier to do for most patients.
Any
food that is liquid when it hits the stomach passes into the
intestine easily. This is the reason to avoid liquids with
calories like soft drinks, juices, Kool-Aid®, sweetened tea,
etc. A single 12 oz soft drink per day for 365 days accounts for
17 pounds of fat calories over a year. Many of the junk foods
are also primarily liquid by the time they hit the stomach. A
single doughnut per day over a year produces 34 pounds of fat
calories. High calorie foods such as cake, cookies, pie, chips,
candy, etc. need to be avoided permanently.
Obesity
surgery doesn't mean that you don't have to diet anymore. What
it means is that if you adhere to the prescribed diet for the
rest of your life, you'll lose the weight and keep it off. If
you ever go off the diet, you'll gradually begin to regain lost
weight. We want you to implement this sort of diet before
surgery. Weight loss before surgery helps the surgeon by making
laparoscopic surgery easier and safer and increases the
likelihood that your surgery can be performed laparoscopically.
Other dietary requirements are basic ‘common
sense’ eating. With sensible eating and exercise habits
(three sensible meals a day with healthy snacks), the weight
loss can be easily maintained after surgery.
Exercise,
though probably difficult for you now, should become part of
your daily routine as you lose weight. With weight loss,
patients have less joint pain, less shortness of breath, and
more endurance. We encourage all patients to adopt an exercise
regimen such as walking, swimming, aerobics, or any other form
of physical fitness. This not only increases caloric
expenditure, but metabolism as well, thus helping with weight
loss and maintenance. We also suggest weight training since
building muscle tissue (muscle tissue burns calories 24 hrs a
day) increases and helps maintain maximum weight loss.
In
addition to changing eating behaviors, you also require lifetime
vitamin supplementation, including multivitamin, iron, B12, and
calcium. Occasionally, others (vitamins A, D, and/or E) are
required as well. You need to monitor blood on a yearly basis to
determine appropriate doses of these vitamins.
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| Obesity
Surgery : |
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| Weight
loss surgery : |
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| Gastric Bypass : |
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| Gastric Banding : |
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